Abstract
Introductionthe principal burden of human papillomavirus (HPV) infections is cervical cancer. Cervical cancer ranks as the fourth most common malignancy in women affecting 500,000 women each year with an estimated 266,000 deaths. Uganda has one of the highest cervical cancer incidence rates globally with an age-standardised incidence rate per 100,000 of 47.5. This study assessed the level and the factors associated with uptake of HPV vaccine by female adolescents in Lira district, Uganda.Methodsa mixed methods approach was employed using a survey among 460 female adolescents. We collected data using an interviewer-administered questionnaire. We interviewed five key informants and conducted ten in-depth interviews. Uptake was defined as completing three doses of the vaccine as per the recommended schedule. Prevalence risk ratios were used as measures of association and were computed using modified poison regression. Content analysis was used for qualitative data.Resultsthe mean age of the respondents was 13.97 (SD=1.24). Uptake was at 17.61% (81/460). The factors associated with uptake of HPV vaccine were: attaining ordinary level of education (aPR 1.48, 95%CI 1.11-1.97), positive attitude towards the vaccine (aPR 3.46, 95%CI 1.70-7.02), receiving vaccine doses from different vaccination sites (aPR 1.59, 95% CI 1.10-2.28) and encouragement from a health worker (aPR 1.55, 95%CI 1.15-2.11) or Village Health Team (aPR 3.47, 95%CI 1.50-8.02) to go for the vaccine. Other factors associated with uptake of HPV vaccine included; the existence of community outreaches (aPR 1.47, 95%CI 1.02-2.12), availability of vaccines at vaccination sites (aPR 4.84, 95%CI 2.90-8.08) and receiving full information about the vaccine at the vaccination site (aPR 1.90, 95%CI 1.26-2.85).ConclusionHPV vaccine uptake was low in Lira district. Efforts to improve uptake of HPV vaccine should focus on ensuring a consistent supply of vaccines at the vaccination sites, health education aimed at creating a positive attitude towards the vaccine, sensitisation of the adolescents about the vaccine and conducting community outreaches.
Highlights
A woman's lifetime risk of acquiring human papillomavirus (HPV) infection is higher than 80%, and most infections occur within 3-4 years of sexual debut [1]
We found out that there was a 47% higher prevalence of HPV vaccine uptake among adolescents who reported that HPV vaccine community outreaches were conducted in their residences
Factors found to be associated with HPV vaccine uptake included: attaining an education of secondary ordinary level, positive attitude towards the vaccine, receiving vaccine doses from more than one site and encouragement from Health workers and Village Health Teams
Summary
A woman's lifetime risk of acquiring HPV infection is higher than 80%, and most infections occur within 3-4 years of sexual debut [1]. The principal burden of HPV infections globally has been cervical cancer. The World Health Organization recommends HPV vaccination for girls aged 9-14 years as the most cost-effective public health intervention against cervical cancer. In Uganda, cervical cancer ranks as the most frequent cancer among women aged between 14 and 15 years. Many girls and women in Uganda stay without routine HPV vaccination and cervical cancer screenings because of lack of awareness, limited availability of vaccination and screening programs [5, 6]. In Uganda, HPV vaccination was first piloted in 2008 in Nakasongola and Ibanda districts. It was later piloted in 12 other districts in 2012. This study assessed the level and the factors associated with uptake of HPV vaccine by female adolescent girls in Lira district, Uganda to inform implementation of the HPV vaccine program in Uganda
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